TTB F 5130.6 Drawback on Beer Exported

OMB No. 1513-0017

DEPARTMENT OF THE TREASURY

1. SERIAL NUMBER (The exporter
will number each form beginning
with "1" each January 1.)

ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

DRAWBACK ON BEER EXPORTED
( Prepare in quadruplicate. See instructions on Page 2.))
PART I - NOTICE
NOTICE IS HEREBY GIVEN OF THE SHIPMENT OF TAXPAID BEER ON WHICH DRAWBACK OF INTERNAL
REVENUE TAX PAID THEREON WILL BE CLAIMED BY THE PRODUCING BREWER.

CLAIM NUMBER

2. NAME AND ADDRESS OF EXPORTER (Number, street, city, State, and ZIP Code)
3. NAME AND ADDRESS OF PRODUCING BREWER

3a. EMPLOYER IDENTIFICATION
NUMBER1

AMOUNT CLAIMED
$

(Location)
(Number)
5. PURPOSE SHIPMENT FOR EXPORT TRANSFER TO
TO ARMED FORCES
OF
FOREIGN-TRADE
OF THE U.S.
SHIPZONE
MENT
EXPORTATION TO (Name of foreign port and country)
(Make
applicable
USE AS SUPPLIES ON
entries)
A VESSEL3
AIRCRAFT3

AMOUNT REJECTED
$
AMOUNT APPROVED
$
CLAIMS CLERK

DIRECTOR OF CUSTOMS AT PORT OF
TRANSPORTATION
OFFICER

7. NAME OF DOMESTIC CARRIER

(Name)

CUSTOMS OFFICER IN
CHARGE OF FOREIGN-TRADE
ZONE

DATE RECEIVED
TTB F 5620.4 FILED WITH CLAIM
NO.2

4. ADDRESS OF THE DIRECTOR, NATIONAL REVENUE CENTER,
550 MAIN ST, STE 8002, CINCINNATI, OHIO 45202-5215

6. CONSIGNED
TO OR IN
CARE OF
(Make
applicable
entries)

FOR TTB
USE ONLY

(Location)
8. NAME OF EXPORT CARRIER

(Location)

(Number)

9. THE BEER WAS SHIPPED IN THE FOLLOWING CONTAINERS (Show container size as "1/4 bbl", "24/12", etc.)
NUMBER
SIZE
NUMBER
NUMBER
KIND
SIZE
KIND
(d)
(f)
(g)
(a)
(b)
(c)
(e)

10. DATE

11. EXPORTER

KIND
(h)

SIZE
(i)

11a. BY (Signature and title)

PART II - CLAIM
TO: DIRECTOR, NATIONAL REVENUE CENTER, ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
The beer described in Part I has been removed for the purpose stated and is not to be brought back or relanded within the limits of the United States. The
quantity of beer, as described in Part I and restated below in terms of barrels, is correct, and such beer was brewed or produced in the United States. I am
justly entitled to drawback of tax in the amount claimed herein. Internal Revenue tax equal to such amount has been determined and paid as provided by law
and regulations. No other claim for allowance of drawback has been made on this beer or any part thereof.
12. DATE

14a. RATE OF TAX4

13. QUANTITY OF BEER (Barrels)

$7

$18

14b. DRAWBACK CLAIMED
$

Under penalties of perjury, I declare that I have examined Part I hereof, and this claim, and to the best of my knowledge and belief the statements herein and
in Part I are true, correct, and complete.
15. BREWER1

15a. BY (Signature and title)

1

The producing brewer must always complete item 3a.
Complete only for consolidated claims; show serial number of last claim tabulated.
3
State whether (a) Vessel or aircraft operated by the United States; (b) Vessel or aircraft engaged in foreign trade, or in trade between the United States and
any of its possessions, or between Hawaii or Alaska and any other part of the United States; (c) Vessel of the United States engaged in trade between
Atlantic and Pacific ports of the United States; (d) Vessel of war of any foreign nation; or (e) Vessel employed in (1) the fisheries, or (2) The whaling
business. Show name of vessel, country of registry, and ports of call, or, if a whaling vessel, location or operations. If aircraft, show also name of airline
and country of registry of aircraft.
4
Indicate the rate of tax paid on the beer which was exported. If the beer was produced by a brewer qualified under 27 CFR 25.152 to pay tax at the
reduced rate of tax, drawback must be claimed at the lower rate of tax unless the brewer or the brewer's agent can establish that the beer was taxpaid at
the higher rate of tax.
2

TTB F 5130.6 (09/2017)

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PART III - CUSTOMS OFFICER'S CERTIFICATION OF LADING OR DEPOSIT
I HEREBY CERTIFY THAT THE BEER DESCRIBED IN PART I WAS FOUND TO BE AS DESCRIBED, EXCEPT AS NOTED IN ITEM 19, AND THAT THE BEER WAS --

16. LADEN FOR

AIRCRAFT (Name, symbols, number)

VESSEL (Name)

USE AS
SUPPLIES

EXPORT

RAILROAD CAR (Number)
ON BOARD
17. RECEIVED IN
(Number)
18. SHIPPED TO (Frontier port)
FOREIGN-TRADE ZONE

TRUCK (State license)
SERIAL NUMBER OF SEALS USED

19. INSPECTION DISCLOSED
NO EVIDENCE OF TAMPERING
20. DATE

NO DISCREPANCY

21. PORT

DISCREPANCIES OR SHORT
SHIPMENT AS FOLLOWS:
22. SIGNATURE AND TITLE OF CUSTOMS OFFICER

PART IV - CUSTOMS OFFICER'S REPORT OF THROUGH SHIPMENT AT FRONTIER PORT
24. DATE REC'D 25. INSPECTION DISCLOSED
NO EVIDENCE
SEALS INTACT
OF TAMPERING
26. NATURE AND EXTENT OF DISCREPANCIES, TRANSSHIPMENT, RESEALING, ETC.
23. FRONTIER PORT

27. THE EXPORTING CONVEYANCE IDENTIFIED IN ITEM 16, BEARING THE BEER
DESCRIBED IN ITEM 9, WITH EXCEPTIONS AS NOTED IN ITEMS 19 AND 26,
CLEARED FROM THIS PORT FOR THE PORT OF
28. DATE
29. SIGNATURE AND TITLE OF CUSTOMS OFFICER

SEALS BROKEN
(See item 26)

FOREIGN PORT

PART V - CERTIFICATE OF CLEARANCE OR USE
30. THE EXPORTING CONVEYANCE BEARING THE BEER DESCRIBED IN ITEM 9, WITH EXCEPTIONS AS NOTED ABOVE -ON (Date)

CLEARED FROM THE PORT OF

BOUND FOR (Foreign port)

33. SIGNATURE OF DIRECTOR OF CUSTOMS
32. DATE
31. THE BEER HAS BEEN USED AS SUPPLIES ON THE
FISHING VESSEL IDENTIFIED ABOVE, AND THE
EVIDENCE OF SUCH USE HAS BEEN RECEIVED
PART VI - CERTIFICATE OF RECEIPT BY ARMED FORCES OFFICER
The beer described in Part I, with exceptions as noted in item 35, was received for export to the Armed Forces of the United States. The beer will not be
shipped for consumption or use in any place subject to application of the Internal Revenue laws of the United States.
34. DATE

35. DISCREPANCY

36. SIGNATURE

37. RANK

38. TITLE

INSTRUCTIONS
1. GENERAL. Prepare a separate TTB F 5130.6, in quadruplicate, for the products
of each brewer. Under 27 CFR 28.226 an agent is a person who has on file with
the Director, National Revenue Center, Alcohol and Tobacco Tax and Trade Bureau, a
TTB F 5000.8, Power of Attorney, authorizing him/her to act on behalf of the principal.
2. SHIPMENT BY BREWER OR BREWER'S AGENT. Complete Parts I and II,
forward the original and one copy to the official designated in item 6, forward one
copy to the Director, National Revenue Center, Alcohol and Tobacco Tax and Trade
Bureau at the address shown in item 4, and retain the remaining copy for filing.
3. ACTION BY CUSTOMS.
(a) Shipment for Direct Exportation. After inspection of lading, the Customs
Officer must execute Part III on both copies and forward them to the Director of
Customs. On clearance at the conveyance, the Director of Customs must execute
Part V, forward the original to the Director, National Revenue Center, Alcohol and
Tobacco Tax and Trade Bureau at the address shown in item 4, and retain the
copy for his/her files.
(b) Supplies on Aircraft and Vessels Other Than Fishing Vessels.
After inspection of lading, the Customs Officer must execute Part III on both copies,
forward the original to the Director, National Revenue Center, Alcohol and Tobacco Tax
and Trade Bureau at the address shown in item 4, and retain the copy for his/her files.
(c) Supplies on Fishing Vessels. After inspection of lading, the Customs
Officer must execute Part III on both copies and forward them to the Director of
Customs. The Director of Customs (on receipt of the required Customers Form 5125)

must execute Part V, forward the original to the Director, National Revenue Center,
Alcohol and Tobacco Tax and Trade Bureau at the address shown in item 4, and retain
the copy for his\her files.
(d) Lading at Interior Port For Exportation Through Frontier Port. On
completion of lading, the Customs Officer must affix the customs seals, then execute
Part III on both copies and forward them to the Director of Customs at the interior port of
lading for forwarding to the Customs Officer at the frontier port. (Exception, if the
shipment is by truck and if instructions from the Director of Customs so provide, the
copies may be forwarded via the truck driver to the Customs Officer at the frontier
port.) That officer, when satisfied that the shipment has been exported, must execute
Part IV on both copies and return them to the Director of Customs at the interior port.
The Director of Customs must then execute Part V, forward the original to the
Director, National Revenue Center, Alcohol and Tobacco Tax and Trade Bureau at the
address shown in item 4, and retain the copy for his/her files.
(e) Receipt in Foreign-Trade Zone. On receipt of the beer, the Customs
Officer must complete Part III on both copies, forward the original to the Director,
National Revenue Center, Alcohol and Tobacco Tax and Trade Bureau at the address
shown in item 4, and retain the copy for his/ her files.
4. ACTION BY ARMED FORCES OFFICER. On receipt of the beer, the officer to
whom consigned (or other authorized supply officer) must execute Part VI on both
copies, forward the original to the Director, National Revenue Center, Alcohol and
Tobacco Tax and Trade Bureau at the address shown in item 4,and retain the copy for
his/her records.

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to obtain drawback of Federal taxes on beer exported from the United States.
This information is required to obtain a benefit by 26 U.S.C. 5055.
The estimated average burden associated with this collection of information is 1 hour per respondent or recordkeeper, depending on individual circumstances. Comments concerning the
accuracy of this burden estimate and suggestions for reducing this burden, should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and
Tobacco Tax and Trade Bureau, 1310 G Street, NW, Box 12, Washington, D.C. 20005.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB control number.

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TTB F 5130.6 (09/2017)